home Business blogs Service of remote work on the Internet. Remote work without experience: how I started and a few recommendations for beginners

Service of remote work on the Internet. Remote work without experience: how I started and a few recommendations for beginners

According to various sources, about 1% of babies are born with congenital heart defects, while doctors can only identify the factors that provoked the development of such fetal pathologies in the prenatal period in only 10% of cases. Through early diagnosis and modern methods surgical treatment, most of these children manage not only to overcome death, but also to live, keeping up with their peers.

Heart disease: what is it?

Heart disease - these are changes in the anatomical structures of the heart (chambers, valves, partitions) and the vessels extending from it, which lead to hemodynamic disturbances. All heart defects are divided into two groups: congenital and acquired. AT childhood Congenital heart defects (CHDs) are usually diagnosed. They are of two types:

"Blue", in which venous blood enters the arteries, so the skin becomes bluish. This group of congenital heart diseases is the most dangerous, since the organs and tissues of the child, due to the mixing of arterial and saturated carbon dioxide venous blood receives less oxygen. The most common “blue” CHD are pulmonary atresia, Phalo's tetralogy, and vascular transposition.
"White", characterized by a discharge of blood into the right side of the heart and pale skin. Defects of this type are more easily tolerated by patients, but over time they lead to the development of heart failure and the appearance of problems with the lungs. Examples are atrial septal defect, patent ductus arteriosus, etc.

Causes

Congenital heart disease in children develops in the womb, and this happens when the heart is formed - during the first 2 months of pregnancy. If negative factors affect the female body during this period, the risk of CHD in a child increases significantly. The factors leading to the development of heart disease in the fetus include:

Alcohol, nicotine, drugs.
radiation.
Certain drugs (including sulfonamides, aspirin, antibiotics).
Rubella virus.
Unfavorable ecology.

In addition, genetics plays an important role in the formation of heart defects. The mutation of certain genes causes a violation of the synthesis of proteins from which the septa of the heart are formed. Genetic mutations can be inherited, or they can appear due to a woman's use of drugs, alcohol, exposure to radiation, etc.

How to determine a heart defect?

An experienced ultrasound doctor can diagnose heart disease even in utero. Therefore, gynecologists strongly recommend that all expectant mothers undergo planned ultrasound scans. Intrauterine detection of serious CHD in the fetus gives a woman the right to choose: to give birth or not to give birth to a seriously ill child. If a woman wants to carry the pregnancy to the end, organize the birth in such a way that the necessary medical care is immediately provided to the newborn (as a rule, these are resuscitation measures) and as soon as possible operation was performed.

It often happens that intrauterine heart defects are not detected, the child is born, at first glance, completely healthy, and problems arise later. Therefore, in order not to miss CHD, to prevent the progression of pathology and the development of complications, each newborn is carefully examined in the maternity hospital. The first thing that indicates a possible defect is the murmur, determined by listening to the heart. If this is found, the child is immediately sent to a specialized clinic for further examination (conducting EchoCG, ECG and other studies).

However, it is not always possible to detect heart disease in a newborn in the first days of life (murmurs may simply not be heard), so it is important for parents to know what symptoms indicate that something is wrong with the child’s heart in order to consult a doctor in a timely manner. These signs include the following:

Paleness or cyanosis of the skin (especially around the lips, on the handles, on the heels).
Bad weight gain.
Sluggish sucking, frequent respite during feeding.
Rapid heartbeat (the norm in newborns is 150 - 160 beats per minute).

With some congenital heart diseases, pronounced symptoms of pathology do not appear in the first year of life, but later. In such cases, the presence of heart disease can be suspected by the following signs:

In addition, parents should regularly take the child to the pediatrician or family doctor (in the first year of life - every month, thereafter - annually), since only a doctor can hear heart murmurs and notice what dads and moms do not pay attention to.

If someone in the family has CHD or the pregnancy proceeded against the background of aggravating factors (endocrine and autoimmune diseases of a woman, severe toxicosis, threat of abortion, infectious diseases, taking medicines, smoking and alcohol abuse, etc.), it is advisable for a child to examine the heart with echocardiography even in the absence of any pathological symptoms.

Treatment and prognosis

The approach to the treatment of CHD is always individual. For some patients, the operation is performed immediately after birth, for others - after six months, and for the third, doctors treat conservatively, without any surgical interventions. Congenital malformations that are well tolerated by patients and do not always require surgical correction (since they often close spontaneously) include the following:

Small defects in the septa between the ventricles and the atria.
Open ductus arteriosus.
Minor deformities of the heart valves.

The prognosis for these CHD is usually good, even if surgery is required.
Much worse is the situation with most of the "blue" vices. These vices are more complex and more dangerous. The most severe VPS include:

Transposition (change of places) of the aorta and pulmonary artery.
Origin of both aorta and pulmonary artery from the right ventricle.
Tetradu Falo (includes immediately 4 anomalies in the development of the heart and great vessels).
Gross valve defects.
Hypoplasia (underdevelopment) of the heart. A particularly dangerous defect is the underdevelopment of the left departments. The question of how long they live with it can be answered with statistical data - with such a defect, almost 100% mortality is noted.
Atresia (fusion) of the pulmonary artery.

With severe CHD, heart failure rapidly increases, children immediately after birth go into a very serious condition that requires immediate surgical intervention. The success of such treatment directly depends on how quickly the newborn is delivered to a specialized cardiac surgery clinic and how the treatment tactics are chosen correctly. Compliance with these two conditions is possible only in one case - if the defect is detected before the birth of the child. Intrauterine diagnosis of CHD enables doctors of all levels (both obstetrician-gynecologists and cardiac surgeons) to prepare for the upcoming birth and plan a surgical intervention on the newborn's heart.

If your baby has been diagnosed with such a diagnosis - “heart disease in a child”, do not fall into despair. Heart defects are treated. Today we will talk about some of the features of caring for babies with heart defects.

How to identify a child's heart disease? Recall how the heart works. It has four chambers - two ventricles and two atria, divided by a longitudinal septum into two non-communicating chambers. Arteries carry oxygenated blood from the heart to all parts of the body. The veins carry the oxygenated blood from the organs back to the heart.

Congenital heart defects are varied. The most common defects of the interatrial and interventricular septum - a hole appears in it and part of the arterial blood from the left half of the heart enters the right - venous. This leads to malfunctions in the circulatory system. Less blood is supplied to the systemic circulation than it should be - the supply of oxygen to the body is deteriorating. The more arterial blood enters the pulmonary circulation, the more severe the disease.

In children aged 5 to 12 years, doctors detect stenosis - a narrowing of the opening of the pulmonary artery, because of which the blood flow from the right ventricle to the pulmonary circulation is disturbed. Children with mild stenosis grow and develop normally. With a severe stage of stenosis, shortness of breath, tachycardia, pain in the heart appear in babies. The defect is treated surgically.

The next type of defect is narrowing of the aorta. In this case, children grow up without painful manifestations. But at the age of 4 to 10 years, with physical exertion, children may experience dizziness, headaches, nosebleeds, pain in the legs. Another symptom is constantly cold feet. The diagnosis is based on measuring the pulse and blood pressure in the arms and legs. With coarctation, the measurement results are not the same. Surgical treatment.

The most complex heart disease is Fallot's tetralogy. Cyanosis of the skin and shortness of breath appear in the child in the first months of life. In a severe form of the disease, children experience anxiety, convulsions, and a short-term loss of consciousness. Even with a slight physical exertion, for example, when walking, climbing stairs, the baby suddenly squats down and even lies on his side, legs tucked to his chest. Babies with Fallot's tetrad require surgery.

Heart disease symptoms

How to identify a child's heart disease? What should parents be concerned about? Pain in the region of the heart in a child. They can occur with circulatory disorders in the heart muscle, with inflammation of the pericardium, but may not be associated with heart defects.

For example, in diseases of the lungs, neuralgia, inflammation of the muscles and diseases of the spine.

How do these pains manifest themselves? Trite - when walking or running fast, the baby complains that he has a "prick in his side." Parents often brush aside such complaints: “If you grow up, it will pass.” Any pain in the chest is a reason to show the child to the doctor. In newborns, heart disease is indicated by bouts of unreasonable anxiety, accompanied by poor appetite, lethargy, and pallor. Children also gain weight poorly, they develop cyanosis of the skin - especially around the mouth, in the area of \u200b\u200bheels and nails.

Heart hump - a bulge in the region of the heart, which can appear as early as 3-4 months. Parents should know the heart rate of children. At the age of up to a year, it is 125-130 beats per minute, at the age of 5-7 years - 90-100, at 8-10 years old - 80-85, at 11-14 years old - 70-85 beats per minute.

Monitor your baby's heartbeat and breathing. Rapid heartbeat occurs when high temperature, physical activity, in the heat, from excitement. But persistent heart palpitations are a sign of cardiovascular disease. Problems can also be indicated by a slowing of the heartbeat - bradycardia. It can also be observed in children who are actively involved in sports.

There are rules for breathing. In the first year of life, the baby takes 30-40 breaths per minute, later this number decreases, at 5 years the number is 25 breaths. At 7-8 years old, the child takes 18-22 breaths, at 10-14 years old - 16-18 breaths. Increased respiration and cyanosis of the skin are observed with Fallot's tetrads.

Causes and treatment

Parents are surprised: Why are babies born with heart defects? No one in our family had a heart defect." Indeed, heredity in this case does not play a big role.

In women who suffer from heart disease, only 5% of children are born with the same disease. Also, children can have acquired heart defects.

The cause of the pathology can be various negative effects on the woman's body in the period from the third to the eighth week of pregnancy - it is at this time that the baby's heart is formed. It can be transferred influenza, rubella, herpes. Diabetes, neoplasms, work in hazardous industries, smoking also affect. Alcoholism is very dangerous - in 30% of cases children are born with heart disease.

Most often, the heart disease is based on a mutation or breakdown of the gene, chromosomal abnormalities. Diagnosis of congenital heart defects should be carried out in the maternity hospital - at the birth of a child. In 10-15% of cases, the opening in the interventricular septum closes spontaneously. Ventricular septal defect is treated with medication, the prognosis is favorable. Now children with heart defects are operated on in the first year of life, this allows them to save their lives and avoid serious changes in the heart and lungs.

A baby with a heart defect should be constantly under the supervision of a cardiologist. Most children who have undergone heart surgery are practically healthy, graduate from universities, create families and forget that they were sick.

In everyday life

How to ensure appropriate care for a child with heart disease? It is important to organize a sparing daily routine. Protect your baby from stress, long trips, do not load circles and sections.

Do not exclude physical education - good walks in the fresh air, walking, games, light gymnastics. Watch your diet - offer your baby fresh vegetables and fruits. Strengthen the immunity of the crumbs, protect against colds. Soft hardening with air baths, rubbing with cool water is shown. Develop a calm attitude towards doctors.

In no case:

do not arrange bed rest for the child, unless the doctor has given instructions;
do not give any medication without a prescription, even if it is vitamins or food supplements;
do not do inhalations, hot foot baths, mustard plasters, plentiful hot drinks are dangerous.

Recently, diseases of the cardiovascular system have become more widespread in pediatrics. Basically - pathologies, conditionally combined into one large group - heart defects. To date, they are observed in every two hundredth child. Having heard the diagnosis, many parents perceive it as a sentence for their baby. Yes, some of these diseases really pose a serious danger to the patient's life. But most often, heart disease in children is quite successfully treated, although sometimes the only method here is surgery.

The human heart consists of four chambers: two atria and two ventricles. Their well-coordinated work ensures normal blood flow and, accordingly, is prerequisite the vital activity of the organism. Defects that occur in the system, affecting the heart valves, septa or blood vessels, lead to a disruption in the flow of blood to various organs, depriving them of a full supply of oxygen. The condition is called heart failure.

congenital - appear in the process of embryo development, children are born into the world, already having a pathology;
acquired - occur after birth, usually at the age of 10 years and older.

Classification and causes of birth defects

Children are quite often born with this pathology (1% of all newborns). Now there are about 90 congenital pathologies that can be combined with each other in various combinations. There are many classifications, and the most common of them, based on the presence or absence of mixing of arterial and venous blood, we will give below:

White. The most famous are open ductus arteriosus, septal defects, isolated stenoses, dispositions and dystopias of the heart. Cyanosis is not observed.
Blue. More common tetralogy of Fallot, transposition of the main arteries, Eisenmenger's complex, Ebstein's anomaly and others.

Blue defects got their name because of the pronounced cyanosis with which they are accompanied. The group of pathologies is united by the reflux of venous blood into the system that feeds all the organs of the child (called the systemic circulation). The resulting "mixture" contains an insufficient amount of oxygen. Therefore, the tissues into which it enters acquire a bluish tint.

It is not yet known exactly why babies are born with such defects. But most doctors agree that congenital heart defects in children have the following causes:

Genetic factors. These include the presence of similar diseases in close relatives of the mother or her previous children. But sometimes signs of a genetic predisposition cannot be detected in advance.
Failed pregnancy. If a mother has previously had a miscarriage or had a stillborn child, this significantly increases the risk of a baby with cardiovascular pathologies in the future.
Bad habits. The use of alcohol or drugs by a pregnant woman, certain medications directly affects the health of the unborn child.
Bad environmental situation. Here it is necessary to take into account not only living in a “clean” zone, but also the profession of a mother. Moreover, work in hazardous production can manifest itself in a few years.
Diseases during pregnancy. The most dangerous in this regard are diabetes mellitus, epilepsy, severe hypertension, various infections (for example, rubella in the mother is likely to lead to the development of a defect in the embryo).

Full information about all types of defects in the article - Congenital pathologies - is there a way out?

Acquired pathologies

Acquired defects in children affect the functioning of the valves, thereby disrupting the blood flow in the body. These defects are of two types:

prolapse - sagging of the leaflets of one of the valves when it is closed, leading to leakage of a certain portion of blood into reverse side(regurgitation);
stenosis - incomplete opening of the leaflets, reducing the throughput of the valve.

The causes of the development of acquired types of the disease are mostly rheumatoid in nature, but sometimes other diseases can also provoke their appearance:

atherosclerosis (children are occasionally affected by this pathology);
syphilis;
diffuse connective tissue diseases.

Most often, children have defects in the mitral valve (about 70% of all patients), and almost all the rest affect the aortic valve. Moreover, in half of the cases, violations are present in parallel in another valve - the tricuspid valve, although the defect is very rare as an independent pathology.

Also, the defect can cause another disease - the formation of an additional chord in the heart. This is just as dangerous pathology, requires immediate intervention.

The main symptoms of congenital and acquired defects are similar, although in each case there may be individual characteristics:

fast fatiguability;
shortness of breath even with little physical exertion;
slow weight gain in young children;
difficulties during breastfeeding;
cyanosis with blue defects;
obvious pathological noises when listening (causes of heart murmurs in a child);
atrial fibrillation.

Often, although not necessarily, there are signs such as heart and headaches, pronounced arteries in the neck, frequent swelling of certain parts of the body. In older children, the symptoms are more pronounced - chest pains are given to the left arm and shoulder girdle.

Naturally, it will be difficult for a person without proper qualification to determine the defect by the above manifestations, since the same fatigue and shortness of breath may indicate any other diseases. Therefore, with such symptoms, it is best to take the child to the doctor.

Treatment

Treatment of defects in each case is developed individually based on various factors, such as the type of pathology, the characteristics of its course, the well-being of the child, his age, and so on. In some cases, by adulthood, the vice disappears on its own. But more often than not, you can not do without medical help. There can be three options that most often complement each other:

drug treatment;
surgery;
preventive actions.

Medicines

Of course, the defect itself cannot be cured with medicines. They are mainly used to relieve symptoms of heart failure. The following drugs may also be prescribed:

non-steroidal anti-inflammatory drugs - with a pronounced reaction to the infection by the "forces" of innate immunity;
angioprotectors - if vascular damage is observed;
antibiotics based on penicillin - when the defect is provoked by pathogenic bacteria;
cardiotrophic therapy - for the treatment of acute insufficiency.

Operation

The only way to completely eliminate defects in the cardiovascular system is surgery. Sometimes the only way to save a child is this way. Surgery is recommended if the following symptoms are present:

after minor physical exertion, the patient immediately experiences shortness of breath, and other signs of insufficiency are also observed;
diagnostics shows a pathological increase in any of the heart chambers and its work "for wear and tear";
pressure rises in one of the ventricles.

Preventive measures

Effective treatment of the defect is impossible without the child following the correct regimen:

The patient's diet should be balanced, with a high content of calcium, magnesium, potassium and manganese (most of them are in oatmeal, pearl barley, buckwheat, apples and prunes). At the same time, it is undesirable to focus on salted and pickled foods, preservation. It is better to eat smaller portions, but more often.
The child should go to bed on time, because proper rest significantly reduces the load on the heart.
The patient must be protected from situations that may lead to overexcitation or frustration. It is also not recommended to load it physically.
Regular walks are simply a must, of course, if the weather is comfortable outside.

The defect in children is curable in the vast majority of cases. Moreover, the main point here is the timely application for medical care, since such diseases cannot be “defeated” by any folk methods. Only a qualified specialist will be able to determine why this pathology has arisen and what method of treatment is best for the child.

The appearance of a baby in the family is always happiness. But the joy of parents fades sharply when they hear such a diagnosis as heart disease. Unfortunately, in recent years, heart defects in children are quite common. This disease is associated with impaired development of the heart and large vessels in babies, which leads to changes in blood flow, overload and myocardial insufficiency. Heart disease in children is congenital. According to statistics, from 5 to 8 children out of a thousand have this cardiovascular disease. All types of congenital pathologies are diverse in their anatomical features and the severity of the flow. Many of them are found in various combinations. With forms incompatible with life, children do not live up to a year. After the first year of life, mortality decreases, and in the period from 1 to 15 years, about 5% of sick children die from heart defects. As you can see, the disease is very serious, requiring a special approach and comprehensive treatment.

Heart disease symptoms

Some types of birth defects are diagnosed and successfully treated in the early stages, and some are asymptomatic for months or even years. After three years, the following deviations can be noticed in sick children:

Older children may also complain of pain in the chest or under the shoulder blade, dizziness and headaches. Symptoms of heart disease in newborns may differ depending on specific anomalies, but common to all are heart failure, as well as insufficient supply of nutrients and oxygen to tissues and organs.

According to the features of the discharge of blood, congenital heart defects are blue and white. As a rule, a decrease in the concentration of oxygen in the arterial blood manifests itself with the birth of a baby. Due to metabolic disorders, toxic metabolic products accumulate in the blood. The basis of this phenomenon is the mixing of arterial and venous blood inside the heart. These are blue vices, in which the child has cyanosis of the skin, auricles, lips, as well as rapid breathing.

White defects are characterized by discharge of venous blood from left to right. With white defects in babies, blanching of the skin and cold extremities are observed. Having a defect in the form of a heart disease, the child quickly gets tired during feeding, sucks badly at the breast. The pediatrician may hear heart murmurs and note slow weight gain. However, heart murmurs may not always mean the presence of a disease. Therefore, if a heart disease is suspected in newborns, a consultation with a cardiologist is necessary.

To date, it is not possible to determine the cause of congenital heart defects in children. This vital organ is laid down and formed from the 2nd to the 8th week of pregnancy, that is, during the period when a woman often does not yet know about motherhood. Therefore, it is very important at this time to avoid influence harmful factors that can lead to the development of defects. The most important among them are the following:

maternal bad habits (smoking, drug use)
the influence of certain drugs (antibiotics, hormonal pills)
heredity
gene and chromosomal mutations
chronic diseases of a woman (diabetes mellitus, endocrine diseases)
infectious diseases that a woman suffered during pregnancy (rubella, herpes, flu)
excessive exposure, radiation
harmful working conditions
woman's age (over 35)

Remember, the earlier heart defects in newborns are detected, the greater the hope for its timely and successful treatment.

Treatment of heart disease

Congenital heart defects in children are treatable in 90% of cases. Today, thanks to modern medicine, this disease is successfully cured. Like any other disease, heart disease is easier to treat if it is detected at an early stage. Therefore, as soon as you notice unusual changes in the behavior and condition of the baby, contact a specialist. An additional examination will be scheduled if the doctor confirms that the symptoms present may be signs of heart disease. Heart disease can be diagnosed from birth in the first 3 months of a child's life using the following methods:

1) electrocardiography - this ultrasound method helps to determine how the heart works, its structure, and also checks the function of the valves,

2) cardiac catheterization - this method allows you to determine any defects, their size, location and severity,

3) echocardiography is a very accurate diagnostic method that allows you to assess the structural features and contractility of the myocardium.

Congenital heart disease in children can be diagnosed even in utero. As a rule, this can be done starting from the 14th week of pregnancy, when the woman undergoes an ultrasound. At the slightest suspicion of a heart disease in the fetus, and also if a woman is at risk, she is sent to specialized agency. If a congenital heart disease is found in the fetus, then the birth will take place under the supervision of specialists, in a specialized hospital, where the child will subsequently be operated on.

Children with mild heart disease need observation by a cardiologist and regular check-ups. Over time, their heart can grow on its own. With heart disease in a newborn, it is necessary to be in the fresh air more often, to protect it from infections and stress. Treatment of heart disease depends on the degree of its complexity. Severe defects require surgical intervention in the first days of the baby's life. Sometimes operations are carried out in several stages: initially, the child's condition is relieved, and then they are already prepared for the operation to completely eliminate the defects.

Heart disease surgery can be open or closed. During a closed operation, the heart is not affected, and the operation is performed on the large blood vessels around it. In open surgery, the cavity of the heart is opened. At the time of the operation, the heart and lungs are switched off from the circulation. And the blood is enriched with oxygen and pumped throughout the body with the help of a heart-lung machine. After surgery, children need high-calorie nutrition and intensive care.

If your child has a heart defect, do not panic - modern medical technologies allow you to treat all types of defects and give positive results.

Congenital heart defects in babies are rare and may not appear outwardly at first. Therefore, pediatricians and parents sometimes do not pay due attention to this pathology, which, meanwhile, often requires urgent help. You need to know about congenital heart defects in order to help the baby in time.

Congenital heart defects are anatomical defects of the heart, its valvular apparatus or blood vessels that have arisen in utero, before the birth of a child. They occur with a frequency of 6-8 cases per thousand births and rank first in terms of mortality of newborns and children of the first year of life.

It is sad but true that even with careful monitoring of pregnancy, doctors often miss congenital heart defects. This is due not only to the lack of sufficient qualifications of specialists in this field (the pathology is rare - there is little experience) and imperfect equipment, but also to the peculiarity of the fetal blood flow.

Therefore, even if the pregnancy proceeded favorably and all the necessary examinations were completed, you need to check the baby's heart after birth. Unfortunately, as part of the medical examination, the range of mandatory screening methods of examination in 1 month includes only electrocardiography. However, there may be no changes on the electrocardiogram at this age even with complex congenital heart defects. In addition, not all clinics have staff who are trained to take an ECG film in infants. You can 100% exclude the presence of congenital heart disease by resorting to such a study as echocardiography, or ultrasound of the heart. But on one condition: if it is performed, it will be an experienced doctor. Not all clinics have such a device and a highly qualified specialist. If congenital heart disease is suspected, the pediatrician sends the child to perform this study in another clinic or cardiac surgery center. However, some congenital heart defects in the first months of life are asymptomatic, i.e. have no manifestations, or they are very slight. To be sure of the health of the baby, parents can do this study without a referral, for a fee at the medical center.

What can alert the doctor and parents?

Who is forewarned is forearmed
It is very important to identify problems in time. And this can be done even in utero with the help of an ultrasound examination of the fetus. In the early stages () it is easier for a specialist to identify congenital heart disease with transvaginal (transvaginal) ultrasound. However, some pathologies of the heart and blood vessels are detected at a later date, therefore, if they are suspected, it is necessary to do a transabdominal (through the anterior abdominal wall) ultrasound of the fetal heart c. First of all, it is necessary to think about this for those women who have had spontaneous abortions and stillbirths, have children with congenital malformations, including congenital ones, as well as arrhythmias (heart rhythm disturbances). In addition, the risk group includes:

women who have had a viral infection in early pregnancy, especially in the first two months, when the main structures of the heart are formed;
families in which future parents or close relatives have also been diagnosed with congenital heart disease;
women with diabetes and other chronic diseases who took medication during pregnancy;
expectant mothers over 37;
women who used drugs during pregnancy;
women living in ecologically unfavorable areas.

It should be noted that ultrasound of the fetal heart, or fetal echocardiography, is not performed in every antenatal clinic and a highly qualified specialist is needed who can correctly interpret the data obtained. An obstetrician-gynecologist should refer a pregnant woman to such a specialist if a number of deviations from the fetus were detected during pregnancy monitoring: anomalies internal organs, developmental delay or dropsy of the fetus and, of course, suspicion of abnormal heart formation and fetal rhythm disturbances.

I would like to add that in the presence of a heart disease, none of these signs may be present or they will be expressed very slightly in the first months of a child's life, so it is desirable to perform echocardiography in all children. It is impossible to talk about all congenital heart defects in one article, there are about 100 of them. Let's dwell on the most common ones. These include open ductus arteriosus, ventricular septal defect.

Open ductus arteriosus

This is a vessel that connects the aorta (a large vessel extending from the heart and carrying arterial blood) and the pulmonary artery (a vessel extending from the right ventricle and carrying venous blood to the lungs).

Normally, the patent ductus arteriosus exists in utero and should close during the first two weeks of life. If this does not happen, they talk about the presence of heart disease. The presence or absence of external manifestations (shortness of breath, tachycardia, etc.) depends on the size of the defect and its shape. A one-year-old baby may not have external manifestations that are noticeable to the mother, even with large ducts (6-7 mm).

Respiratory and heart rate in children are normal

An open arterial duct has sound symptoms, and the doctor, as a rule, easily listens to the heart murmur. The degree of its intensity depends on the diameter of the duct (the larger the duct, the louder the noise), as well as on the age of the child. In the first days of life, even large ducts are hard to hear, since during this period the pressure in the pulmonary artery is normally high in children and, therefore, there is no large discharge of blood from the aorta into the pulmonary artery (which determines the noise), since the difference in blood pressure between small vessels. In the future, the pressure in the pulmonary artery decreases and becomes 4-5 times less than in the aorta, the blood flow increases, and the noise also increases. Therefore, doctors in the maternity hospital may not hear the noise, it will appear later.

So, as a result of the functioning of the open arterial duct, more blood enters the vessels of the lungs than normal, from an increased load over time, their walls irreversibly change, become less pliable, more dense, their lumen narrows, which leads to the formation of pulmonary hypertension (a condition, when which increases the pressure in the vessels of the lungs). In the initial stages of this disease, when changes in the vessels of the lungs are still reversible, you can help the patient by performing an operation. People with the last stages of pulmonary hypertension have a short life expectancy and its poor quality (shortness of breath, fatigue, severe limitation of physical activity, frequent inflammatory broncho-pulmonary diseases, fainting, etc.). Pulmonary hypertension is formed only with large ducts (more than 4 mm), and its irreversible stages - usually by adolescence. With a small size of the duct, pulmonary hypertension does not form, but there is a risk of bacterial endocarditis - mainly due to the fact that the blood stream under high pressure "beats" the wall of the pulmonary artery, which changes over time under this influence and is more prone to inflammation than healthy tissue. Bacterial endocarditis is special kind blood poisoning, in which the endocardium (the inner layer of the heart and blood vessels) and valves are affected. Prevention of this disease consists in the fight against chronic foci of infection, which include: carious teeth, chronic tonsillitis (inflammation of the tonsils), chronic adenoiditis (inflammation of the nasopharyngeal tonsil), inflammatory diseases of the kidneys, furunculosis, etc. Even with interventions such as, for example, tooth extraction, it is necessary to “cover” with antibiotics (these drugs are prescribed by a doctor).

In the first year of life, a decrease in large and spontaneous closure of small ducts is possible. When it comes to surgery, parents face a choice. Surgery can be of two types. In one case, the duct is ligated by opening the chest using artificial lung ventilation (that is, the apparatus “breathes” for the child). In the second case, the duct is closed endovascularly. What does it mean? A conductor is introduced through the femoral vessel to the open arterial duct, at the end of which there is a closing device, and it is fixed in the duct. For small ducts (up to 3 mm), spirals are usually used, for large ducts - occluders (they resemble a mushroom or coil in shape, depending on the modification). Such an operation is performed, as a rule, without artificial ventilation, the children are discharged home 2-3 days after it, even the seam does not remain. And in the first case, usually an extract is made on the 6-8th day and a seam remains on the posterolateral surface of the back. With all the visible advantages, endovascular intervention also has disadvantages: it is usually not performed on children with very large ducts (more than 7 mm), this operation is paid for parents, since, unlike the first, the Ministry of Health does not pay for it, moreover, as and after any intervention, there may be complications, primarily related to the fact that a device that is quite large in diameter must be passed through small children's vessels. The most common of these is thrombosis (blood clot formation) in the femoral artery.

Atrial septal defect

It is a message between the two atria (chambers of the heart in which blood pressure is low). Everyone has such a message (an open oval window) in utero. After birth, it closes: in more than half - in the first week of life, in the rest - up to 5-6 years. But there are people who have an open oval window for life. If its dimensions are small (up to 4-5 mm), then it does not adversely affect the functioning of the heart and human health. In this case, an open oval window is not considered a congenital heart disease and does not require surgical treatment. If the size of the defect is more than 5-6 mm, then we are talking already about heart disease - atrial septal defect. Very often there are no external manifestations of the disease up to 2-5 years, and with small defects (up to 1.0 cm) - and much longer. Then the child begins to lag behind in physical development, fatigue appears, frequent bronchitis, pneumonia (pneumonia), shortness of breath. The disease is due to the fact that “excess” blood enters the vessels of the lungs through a defect, but since the pressure in both atria is low, the discharge of blood through the hole is small. Pulmonary hypertension develops slowly, usually only in adulthood (at what age this happens, first of all, depends on the size of the defect and individual features patient). It is important to know that atrial septal defects can significantly decrease in size or close spontaneously, especially if they are less than 7-8 mm in diameter. Then surgical treatment can be avoided. Moreover, as a rule, people with small defects of the interatrial septum are no different from healthy individuals, the risk of bacterial endocarditis is low in them - the same as in healthy people. Surgical treatment is also possible in two types. The first one is with cardiopulmonary bypass, cardiac arrest and sewing in a patch or suturing an atrial septal defect. The second is endovascular closure using an occluder, which is inserted into the cavity of the heart with the help of a conductor through the vessels.

Ventricular septal defect

This is a message between the ventricles (chambers of the heart), in which, unlike the atria, the pressure is high, and in the left ventricle - 4-5 times more than in the right. The presence or absence of clinical manifestations depends on the size of the defect and on which area of the interventricular septum it is located. This defect is characterized by a loud murmur in the heart. Pulmonary hypertension can form quickly, starting in the second half of life. It should be noted that with the formation of pulmonary hypertension and an increase in pressure in the right parts of the heart, the heart murmur begins to decrease, since the discharge through the defect becomes smaller. This is often interpreted by the doctor as a decrease in the size of the defect (its overgrowth), and the child continues to be observed at the place of residence, without being sent to a specialized institution. With the progression of pulmonary hypertension to its irreversible stages, the pressure in the right ventricle becomes greater than in the left, and venous blood from the right heart (carrying blood to the lungs for oxygenation) begins to flow to the left (from which oxygen-rich blood is sent to all organs and tissues). The patient develops cyanosis of the skin (cyanosis), reduced physical activity. In such a state, only a heart and lung transplant can help the patient, which is not done in our country in children.

On the other hand, ventricular septal defects are prone to spontaneous closure, which is associated with the peculiarities of the growth of intracardiac structures in a baby, so they are usually not in a hurry to eliminate them by surgical methods immediately after birth. In the presence of heart failure, the signs of which are determined by the doctor, drug therapy is prescribed to support the work of the heart and monitor the dynamics of the development of the process, examining the baby every 2-3 months and performing echocardiography. If the size of the defect decreases to 4-5 mm or less, then such defects, as a rule, are not operated on, since they do not affect health and do not cause pulmonary hypertension. If it comes to surgery, then the defects of the interventricular septum are closed in the vast majority of cases using cardiopulmonary bypass, cardiac arrest with a patch. However, at the age of over 4-5 years, with a small defect and its certain localization, endovascular closure is possible using an occluder passed through the vessels. It should be noted that it is better to be observed in the center of cardiovascular surgery (doctors there, including echocardiographers, which is very important, have more experience). If the size of the defect decreases to 4-5 mm or less, then such defects, as a rule, are not operated on, since they do not affect health and do not cause pulmonary hypertension.

Heart failure questionable

If a heart disease is suspected in a child, it is necessary to make an appointment with the child as soon as possible for a consultation with a pediatric cardiologist or a pediatric cardiac surgeon, preferably in a cardiovascular surgery center where they can conduct high-quality echocardiographic and electrocardiographic studies and the child will be examined by an experienced cardiologist. The indications and duration of the operation are always set strictly individually. In the neonatal period and up to six months, the risk of complications after surgery in children is higher than in older children. Therefore, if the child’s condition allows, he is given the opportunity to grow up, prescribing drug therapy if necessary, gain weight, during this time the nervous, immune and other systems of the body become more mature, and sometimes defects close, and the child no longer needs to be operated on.

In addition, in the presence of congenital heart disease, it is necessary to examine the child for the presence of anomalies and disorders from other organs, which is often combined. Often, congenital heart defects occur in children with genetic and hereditary pathologies, so it is necessary to consult a geneticist. The more known about the health of the infant before surgery, the lower the risk of postoperative complications.

In conclusion, I would like to note that if, nevertheless, a baby with the defects that we talked about cannot avoid surgical treatment, in the vast majority of cases, after the operation, the child recovers, is no different from his peers, tolerates physical activity well, he will not have restrictions at work, school and family life.

Ekaterina Aksenova, pediatrician, Ph.D. honey. Sciences, NTSSSH them. A.N. Bakuleva RAMS, Moscow

And in the maternity hospital I heard that the child was breathing loudly and often, I asked the pediatrician - they answered me that it seemed. Before discharge, she once again asked the neonatologist to examine - everything is in order, they said, Then she complained to the district pediatrician that the child was breathing very noisily in his sleep - everything is fine! and only in two months the cardiologist found out that we have a heart disease, VSD and 5 * 6 mm, that is, the threshold!!! Thank God it worked out medicines and observation, but after all, it was possible to miss the child !!!

And how do you like the story of Vika Ivanova? She had a heart transplant in India, everything went well. And now her mother writes about it [link-1] and says that there is a sponsor for the operation. Read.

12/30/2015 08:50:16 PM, Arianoanna

She was born with only one half of her heart, and the doctors did not give her much chance of survival. To date, nine-year-old Bethan Edwards has experienced several major surgeries, three of them at the age of five. Her family says Bethan is a warrior who doesn't give up.